EMRA*Cast Nailing the ED Neuro Exam
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Jan 1, 2024 In this engaging discussion, Dr. Rahul Bhat, an emergency medicine physician and vice chair of academics at MedStar Health, shares his insights on mastering neurologic exams in the ER. He explains the HINTS exam as a key tool for accurate diagnoses. The conversation delves into efficient assessment strategies for urgent conditions like stroke and back pain. Dr. Bhat emphasizes the importance of structured techniques and the value of hands-on practice, encouraging residents to embrace ongoing learning to enhance their skills in emergency medicine.
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Rapid Stroke Neurologic Exam
- For stroke assessment, focus on time of onset and have a go-to rapid exam template including cranial nerves and pronator drift.
- Consistently repeating the same exam approach ensures thoroughness and reduces the chance of missing deficits.
Cranial Nerve III Exam Nuance
- A complete cranial nerve III palsy with a normal pupil usually suggests a peripheral infarct, not an aneurysm.
- Partial nerve deficits or pupil involvement raise concern for aneurysm requiring urgent imaging.
Exam Strategies for Altered Patients
- For altered or uncooperative patients, use noxious stimuli gently to elicit movement and assess neurologic function.
- If patients cannot follow commands, focus on responses to painful stimuli to guide evaluation.